Provider Demographics
NPI:1124039490
Name:GRUBMAN, ERIC (MD, FACC, NASPE)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:GRUBMAN
Suffix:
Gender:M
Credentials:MD, FACC, NASPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEVINE STREET
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2193
Mailing Address - Country:US
Mailing Address - Phone:203-789-2272
Mailing Address - Fax:203-865-8614
Practice Address - Street 1:2 DEVINE STREET
Practice Address - Street 2:SUITE # 1
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2193
Practice Address - Country:US
Practice Address - Phone:203-789-2272
Practice Address - Fax:203-865-8614
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036758207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060050666OtherMEDICARE RAILROAD PIN
CT001367582Medicaid
CT060001223Medicare PIN
CTG66303Medicare UPIN
CT060050666Medicare PIN
CT060001223Medicare ID - Type Unspecified
CT001367582Medicaid